残胃癌的淋巴结转移规律及外科治疗

目的探讨残胃癌临床病理学特性和淋巴结转移规律，以及根治性外科手术切除范围。方法回顾性分析32例残胃癌的临床病理学特征、淋巴结转移规律以及手术治疗效果。结果本组残胃癌占同期收治胃癌的4．07％，其中Ⅰ期4例，Ⅱ期7例，Ⅲ期11例，Ⅳ期10例。根治性切除率为77．27％，联合脏器切除率为54．5％，全胃切除31例，剖腹探查1例，全胃切除后消化道再建用Roux-en-Y术式。经腹腔完成残胃癌根治手术26例，经胸腹联合切口完成残胃癌根治手术6例。淋巴结转移率为63．63％，淋巴结转移站别分别为：pN。8例，pN1 16例，pN2 7例，pN3 1例。残胃癌工期和Ⅱ期平均生存时间为（80．17±17．21）个月，中住生存时间为（56．12±19．52）个月；残胃癌Ⅲ期平均生存时间为（31．16±9．15）个月，中住生存时间为（22．0±13．70）个月；残胃癌Ⅳ期平均生存时间为（23．55±6．08）个月，中住生存时间为（16．30±15．30）个月，LogRank=0．0468，差异有统计学意义（P〈O．05）。比较单纯残胃癌根治组与联合脏器切除组、姑息手术组与标准根治手术组及扩大根治手术组、初次胃手术再建为BillrothⅠ与BillrothⅡ、高中分化腺癌组与低分化腺癌组，淋巴结转移阳性与阴性差异都有统计学意义（P〈0．05）。结论对残胃癌外科治疗应选择在全胃切除D2淋巴结清扫基础上进行扩大根治手术和联合脏器切除。

Lymph node metastasis patterns and surgical treatment of gastric stump cancer

Objective To explore surgical treatment and prognosis of gastric stump cancer. Methods 786 patients were performed radical operation for gastric cancer. Among them, 32 cases were gastric remnant cancer. Their surgical treatments, lymph node metastasis patterns, and prognosis were retrospectively analyzed. Results 4.07% were gastric remnant cancer. Radical excision was 77.27 % combined evisceration was 54.5 %. The survival time and median survival time were 80. 17±17.21 months and 56.12fl：19.52 months in stage Ⅰ and Ⅱ gastric remnant cancer. The survival time and median survival time were 31.16 ± 9.15 months and 22.0±13.70 months in gastric remnant cancer stage Ⅲ. The survival time and median survival time were 23.55 ± 6.08 months and 16.30 ± 15.30 months in gastric remnant cancer stageⅣ. There were different of lymph node metastasis from radical excision group and combined evisceration group, palliative operation group and standard radical excision group and extended radical excision group, Billroth Ⅰ and Billroth Ⅱ reconstructed patterns in primary gastrectomy, well-moderate differentiated and poor differentiated adenocarcinoma groups, respectively. Conclusion Total gastrectomy and D2 lymph node dissection are imperative for radical excision of gastric remnant cancer. On the base, extended lymphectomy and combined evisceration can performe appropriately. Stage, lymph node metastasis patterns and biologic character of tumor itself influence prognosis of patients suffering remnant gastric cancer.